This competitive renewal application proposes Jean C. Beckham, Ph.D., for a K24 Mid-Career Investigator Award in Patient Oriented Research. During the previous award period Dr. Beckham was promoted to professor and is currently one of six women professors in a faculty of 489 at Duke UMC Department of Psychiatry and Behavioral Sciences, and an accomplished PTSD and health researcher. Dr. Beckham demonstrates: (a) her strong clinical research interest in PTSD, and accomplishments in the field of comorbid cigarette smoking and PTSD; (b) an outstanding research and clinical environment within Duke UMC in which to conduct patient-oriented research; (c) her unique position within the institution to continue to nurture the careers of junior investigators; and (d) the need for protected research time to continue and expand these efforts. Renewal of the K24 Mid-Career Investigator Award would permit Dr. Beckham to continue her program of patient-oriented research and training for clinical investigators developed during the previous application period, with a focus on smoking cessation and relapse prevention in PTSD and traumaexposed smokers. Cigarette smoking is the number one avoidable cause of death and disability. Psychiatric patients consume 44% of all cigarettes. It is estimated that PTSD affects 2.6 million Americans, and that 1.6 million of these patients are smokers. The comorbidity of PTSD and smoking is a significant public health problem because the risk for smoking dramatically increases among individuals with trauma history or PTSD. The work accomplished in the 3.5 years since the award has allowed Dr. Beckham to renew her R01, obtain an R21, renew her VA Merit review award, apply for a new VA Merit review award, complete an investigator initiated trial of bupropion for PTSD symptoms and smoking cessation in PTSD smokers and undertake an externally funded public health initiative to reduce smoking in returning veterans with and without PTSD. The chief aim of this proposal is to use time liberated by the award to continue her mentorship of clinical researchers and her program of developing, evaluating and disseminating new information on the treatment of smoking and PTSD. The career development plan is to focus on: 1) evidence-based smoking interventions for psychiatric populations; 2) increasing awareness of the health effects of PTSD by educating professionals and the public; and 3) continuing the candidate's mentoring of beginning investigators with the goal of attracting them to a career in patient-oriented research. This application's research plan focuses on ongoing R01 and R21 studies of PTSD, other ongoing research, and a proposed R01 project of an efficacy/effectiveness trial to investigate optimal smoking cessation interventions for PTSD patients. This award would provide critical support for the candidate's career development, mentoring, and ongoing and new patient-oriented research on an understudied, relatively common, and severe co-morbid problem. [unreadable] [unreadable] [unreadable]